Residual cholesterol:a non-predictive marker for major adverse cardiovascular events in patients with intermediate coronary lesions: a large-scale multicenter study

Background Residual cholesterol (RC), a circulating marker of atherogenic lipoprotein remnants, is associated with cardiovascular risk. However, its prognostic significance in patients with intermediate coronary lesions (ICLs)—a group characterized by low anatomical severity yet uncertain clinical risk—remains inadequately defined. Methods This multicenter retrospective study analyzed data from 82 hospitals in China from January 2010 to March 2024. Patients with ICLs were stratified into quartiles based on RC levels: Q1 (RC < 11.87 mg/dl), Q2 (11.87–21.9 mg/dl), Q3 (21.9–35.35 mg/dl), and Q4 (RC > 35.35 mg/dl). The primary endpoint was MACCE, defined as composite of cardiac death, myocardial infarction (MI), cerebral infarction, or revascularization. Secondary endpoints included all-cause death and MI. Multivariable cox regression analysis were performed to explore the associations between RC levels and the endpoints. Non-linear correlations were explored using restricted cubic splines (RCS). Results A total of 14,375 participants (62.61 ± 9.54 years; 56.8% female) were included with a median follow-up of 5.45 years (IQR 5.39-5.54).The higher RC quartiles did not show significant differences in MACCE compared to Q1, Q2 [adjusted hazard ratio (aHR): 1.06, 95% confidence interval (CI): 0.95-1.18, P = 0.27], Q3 (HR: 1.02, 95%CI: 0.91-1.14, P = 1.70), and Q4 (HR: 0.96, 95%CI: 0.85-1.08, P = 0.47). Similarly, all-cause death and MI also showed no significant associations across quartiles (Table 1). These results indicated that residual cholesterol levels were not significantly associated with MACCE, all-cause death, or MI in patients with ICLs. Furthermore, RCS analysis suggested a nonlinear relationship between the RC levels and endpoints (Figure 1). Conclusions Our findings suggest that RC levels may not serve as a critical prognostic marker for MACCE, all-cause death, or MI in this population. These results have profound implications for refining risk stratification strategies in patients with intermediate coronary artery disease.Table 1.Cox analysis ofClinical endoints Figure 1.RCS